Cognitive health is a critical component of healthy aging. As the U.S. population ages, the incidence of dementia and other cognitive health conditions and the cost of providing services to individuals with them are likely to increase. There are an estimated 6 million people living with dementia today in the U.S.; by 2050, that number is expected to more than double to 14 million. This affects both individuals’ and their families’ quality of life and strains health resources. In 2017, the 18.4 billion hours of care provided by unpaid family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. People who provide long-term services and supports Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently. In their basic form, LTSS consist of help with self-care and… to family members, relatives, friends, and neighbors. Some family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. was valued at $232 billion annually.
Health is a critical component of healthy aging. Too often the discussion around cognitive health focuses on disease. According to a 2015 AARP survey, three out of four adults age 40 and older are concerned about their brain health declining in the future.
A groundbreaking 2015 Institute of Medicine (IOM) report refuted the common misperception that cognitive decline is an inevitable part of aging. (IOM changed its name to the National Academy of Medicine in late 2015.) The report presented a scientific consensus that cognitive aging—as distinct from disease—is a natural, lifelong process that happens to everyone as they get older. It stressed that cognitive aging is different for every individual and that some cognitive functions, such as wisdom, knowledge, happiness, and life satisfaction, can improve with age.
While there are no cures yet for Alzheimer’s disease or other causes of dementia, growing evidence suggests that physical exercise, proper nutrition, social interaction, effective stress and depression management, healthy sleep habits, and mental engagement can help maintain cognition and potentially reduce the risks of cognitive impairment and dementia.
A 2017 National Academy of Medicine (NAM) report cited a strong and growing base of evidence that older adults can reduce their risks of dementia and other kinds of cognitive decline as they age. The NAM committee concluded that there were beneficial effects of three classes of interventions that are “supported by encouraging, although inconclusive, evidence: cognitive training, blood pressure management in people with hypertension, and increased physical activity.” When people think of cognitive functioning, they often consider the brain in isolation from the body, but research shows that cognitive and physical health share a strong connection. According to the NAM report, staying physically active and reducing cardiovascular risk factors are the two most important steps that individuals can take to maintain their cognitive health.
In addition, the report stated that the built environment is critical for maintaining cognitive health. For example, walkable communities with safe streets and parks make it easier for individuals to be physically active.
Several other factors that can play a role in cognitive health. For example, recent studies have demonstrated links between hearing loss and cognitive decline, suggesting that more aggressive treatment to correct hearing could benefit cognition. Research also points to a link between an individual’s social environment and their cognitive health, implying that factors such as loneliness and lack of cognitive stimulation are associated with decline.
Scientists have seen impressive growth in evidence indicating ways in which intergenerational programs can have a positive impact on a person’s cognitive health and well-being. This includes participants of all ages improving knowledge and skills, community engagement, health, arts and recreational pursuits, social relationships, self-fulfillment and sense of purpose, cultural pride, and identity.
For example, a 2015 study found that AARP Foundation Experience Corps volunteers age 60 and older who provided an average of 15 hours of tutoring per week in kindergarten through 3rd-grade classrooms experienced less deterioration of the hippocampus and prefrontal regions of the brain than a control group of non-volunteers. Additional research found that students in Experience Corps classes learn to read at a pace above their grade level and often outperform students who do not participate on the classes.
Encouragingly, the overall incidence of dementia among older adults in the U.S. may be declining. A 2014 longitudinal analysis of four decades of the Framingham Heart Study found the rate of dementia among people age 60 and older had declined by 42 percent from the 1970s to the 2000s. Adults age 60–69 experienced the greatest improvements. The authors cited increased education level attainment and the prevention or management of heart disease as potential causes. Despite this promising research, the number of people living with Alzheimer’s disease and related types of dementia is projected to increase, simply because more people are living longer: Advanced age is the leading risk factor for dementia.
In addition to promoting age-friendly communities that support body and brain health for people of all ages, AARP believes that society and communities across the country need to act proactively to respect, empower, engage, and embrace people with dementia. Communities should support the well-being of people in all stages of dementia who are trying to live normal lives there (see also this chapter’s section on Specific Needs and Services—Dementia Treatment for recommendations on treating people with dementia in health care systems).
As people live longer, the need for easy-to-understand, trustworthy information on how to maintain cognitive health will be greater than ever.
PROMOTING COGNITIVE HEALTH: Policy
Cognitive health as a public health priority
Policymakers should make maintenance of cognitive health a public health priority. This includes funding and promoting more research on the risk of cognitive impairment, interventions aimed at preventing or reducing cognitive decline, maintaining cognitive health, and identifying cost-effective approaches for delivering high-quality dementia care.
This need should be met with unbiased consumer education. Medical professionals will also require evidence-based guidelines for developing and reviewing interventions to prevent or reduce cognitive decline and maintain cognitive health.
Public and private-sector programs should support healthy living to help reduce the risk of cognitive impairment. Policymakers should expand and bring to scale demonstrations that are cost-effective and proven to reduce risk. Age-friendly communities, which encourage and facilitate lifestyles conducive to both good physical and brain health, should continue to be supported and expanded. Public policymakers and the private sector should develop and expand intergenerational programs to promote brain health and to care for those with cognitive impairment.
Health care systems and private and public health insurance companies should develop, as appropriate, evidence-based intergenerational programs and materials on cognitive health across the life span. Policymakers should develop and conduct culturally sensitive, linguistically appropriate educational programs on cognitive health. Individuals and organizations that improve interventions and care for dementia should be recognized and promoted in their communities.
Ensuring appropriate regulation
The federal government should ensure appropriate regulatory review, policies, and guidelines for interventions that claim to maintain cognitive health and prevent or reduce cognitive decline.